Letter to the Editor

It was very interesting to read Barry Slaughter Olsen’s article in the May-June issue. I’ve just experienced the full impact of this change in my work as a medical interpreter. I hope my story can help explain why the change to remote interpreting has been viewed in a negative light so far in this field and how we can improve the situation.

Last February the health care network where I’ve worked for the past five years let 50 of my interpreter colleagues go. About 20 of our team remained. Only 10 of us were in full-time positions, since an interpreter was needed to cover each hospital and two interpreters were necessary to cover all the clinics in town. The rest of the work was left to phone and video remote interpreting.

I was probably one of the people left on the team because I’ve always promoted the use of new technology. At the clinic where I worked, I prompted nurses to use phone interpreters for all phone calls to patients. I was expecting the arrival of an iPad, hoping it could be used for the appointments that my colleague and I couldn’t cover, or so we could finally take some time off without leaving the clinic unattended. We also started discussing plans to implement telemedicine. I had also suggested the possibility of having us be able to work remotely, considering one of the clinic’s big challenges was the limited amount of space available.

When the health care network’s leadership implemented remote interpreting technology, it happened very swiftly. They didn’t ask for feedback from interpreters or providers, and they didn’t consider the differences in needs and requirements for each setting, like Mr. Olsen’s article very wisely recommends.

The implementation of remote interpreting capability turned out to be a fantastic development for many areas within the health care network. Adult clinics, for example, had language access for the very first time. Speakers of languages other than Spanish suddenly had immediate access to an interpreter, no matter how rare the language, where before they had none.

Unfortunately, in other settings like pediatrics, the change has been short of catastrophic. For example, I was sent to a pediatric clinic to help relay a sensitive diagnosis to a mother. When I introduced myself to her in the waiting room, I was horrified when she told me she had been asked to bring a family member who could interpret for her. I immediately corrected this misunderstanding and contacted the manager. The manager was apologetic and said she had already talked with her staff. It turns out the providers were refusing to use the phones and video remote interpreting system, in part because of connectivity issues. The implementation had been so swift that there had been no time to test the technology before it started. The connection often dropped, not all rooms had phone jacks, there were dead spots in hospitals where the iPads didn’t pick up the connection, there were not enough phones and iPads, and the technical team was not prepared to deal with all the requests. However, these are all things that can eventually be fixed.

The most concerning reports were about the actual interpreting service. Even though the interpreting company contracted by the health care network had promised to hire certified medical interpreters, in actuality very few of them were certified. As a result, providers working in genetics started to complain about phone interpreters not being knowledgeable enough to handle the appointments smoothly. Providers in highly complex or sensitive clinics in the network also complained about interpreters not being adequately prepared. Another colleague observed a video remote interpreting encounter where the interpreter seemed very qualified, but was apparently based in Costa Rica and had trouble understanding the TexMex jargon and the cultural cues.

A nurse saw me as I was walking through the hospital and asked me to help with a hospital discharge. I encouraged her to use the phone or the video remote interpreting system, but she waived me off saying, “It’s ok. The patient speaks enough English and can help his mom.” Horrified, I ran after her to stop the nonsense. When I saw the patient, I blanched. I knew him. He was a patient from my old clinic who suffers from a mild intellectual disability. He had been interpreting the encounter.

These are only a few of the innumerable frightening stories I’ve seen during the past three months. In short, the difficulties for providers have been so great with the new system and the lack of quality interpreting that they find it more effective to “wing it” in Spanglish with the patients.

Why is this happening? The answer has nothing to do with resistance to new technology. It’s happening because there was no research and no consulting with interpreters and providers before implementation. It also seems that greed got the best of some interpreting companies, and rather than hiring certified interpreters, they’re hiring any bilingual individual because they can pay them less.

Technology is a tool. When used as such, it can help us accomplish great things within our profession. However, when technology is employed as a way of replacing human knowledge and expertise to save money, it can only lead to poor and often dangerous results.

While the leadership in the medical world figures this out, I recently handed in my resignation and have accepted a position as a translator with the local school district. I’m excited to go back to translation and return to the educational setting. Change is not only inevitable, but also nice once in a while.

Let’s welcome change and progress in our professions, but always on the basis of research and best practices. We should never lose the ultimate goal of guaranteeing smooth communication between our clients. The medical world will eventually figure out that technology should only be in the capable hands of certified interpreters. In the meantime, I can only hope that the translation world will handle the advances in neural network technology more wisely.

2 Responses to ""

I read this article and literally felt like my personal job experience was on stage.
The hospital I was employed at also decided to close our Interpreter Services department for ‘financial’ reasons last year.
First it began with taking away weekend interpreters. Then a few months later taking away the overnight interpreters.
A telephonic service was implemented with sporadic training by someone in house, not even a trained expert from the company was provided to do the training. 4 months later we were all laid off.
Medical staff was upset and frustrated with the news. Many had yet to be trained.. Many questioned about true emergencies and what about the departments where you cannot use outside equipment? No one seemed to have an answer. It was all about saving money and everyone will be fine you just need to have patience.
I was fortunate enough to find a job 3 months later in the same community and continue to hear stories of the lack of medical interpreting that continues at the hospital with the new telephonic system.
Patients are having to fend for themselves using their cell phones or sit and wait until the medical staff can get someone on the phone or the medical staff themselves use their personal cell phones or hand gestures to communicate.
Some of the medical staff is unwilling to use the equipment because it takes too long or the knowledge of the ‘medical’ interpreter online, the calls get dropped, not sure of the dialect, and let us not forget the Spanglish which many feel is good enough to use for medical interpreting, etc. The hospital will get it’s quarterly reports and of course it will show savings. What they are not admitting to is the telephonic service is not being used to it’s full potential. As long as the hospital feels the savings is greater to use a machine vs a staff medical interpreter no changes will be made. I also agree that new technology has it’s place in all walks of life but when it comes to medical interpreting a machine is not always the answer just because it saves a dollar or two! We are talking about a human being not an object to be figured out at random by a machine!
Thank you Melissa Gonzalez. Your story gives me hope to push forward.

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